Music therapy and speech pathology are working together to help people with Parkinson’s to improve communication – a common and serious symptom of the condition.
A singing-based program, based on music therapy and speech pathology principles, has been piloted with people with mild to moderately severe Parkinson’s. It is enabling them to speak more loudly and clearly, helping to combat a serious symptom of the disease. Through group singing, vocal exercise and communication activities, participants strengthen their voice and breathing, improve speech clarity, and gain confidence.
ParkinSong was developed by researchers at the National Music Therapy Research Unit at the University of Melbourne, in partnership with Parkinson’s Victoria. More than 300 people living with Parkinson’s are taking part in ParkinSong groups across Victoria, Australia, with their carers.
One participant’s daughter said that her dad used to speak too softly to be heard on the phone. Being part of a ParkinSong group has helped him to speak more loudly, which makes phone conversations more comfortable.
The program also helps participants to feel less anxious and more confident in social situations. For example, one participant who used to be quiet at dinner parties reports that they now have the confidence to talk and communicate with their partner and friends.
Watch: ParkinSong in action
One of the most common symptoms of Parkinson’s is impaired speech, which affects up to 90 per cent of people with the disease. People may speak softly or quickly, slur their words, have difficulty finding the right word or sentence, or hesitate before talking. Their speech may sound monotonous, and their voice may not rise and fall normally. The person’s confidence and drive to engage in conversation may also be diminished.
These symptoms make it difficult for people to have conversations, interact socially and take part in activities. They can also have a negative effect on mental health, leading to disorders such as depression and anxiety.
Therapy that relieves communication impairment improves the quality of life of people with Parkinson’s.
Parkinson’s is a disorder of the nervous system that affects movement, balance and coordination, as well as non-motor functions like mood and sleep. More than 6 million people worldwide live with the disease, around 80 000 of them in Australia. As the global population is ageing, the disease is expected to become more common.
Parkinson’s is progressive, which means the symptoms get worse over time.
Developing the solution
Singing uses many of the same brain networks and parts of the body that we use when speaking. Earlier studies in neurorehabilitation showed that singing might be able to slow down or reverse some of the speech impairments associated with brain disorders like Parkinson’s.
In 2015, Parkinson’s Victoria partnered with researchers at the National Music Therapy Research Unit to look at the long-term benefits of singing and socialising for people with Parkinson’s.
The team, led by University of Melbourne music therapist Dr Jeanette Tamplin, designed a therapy program that includes vocal and breathing tasks, speech exercises, group singing, and social communication.
The researchers designed ParkinSong as an activity that participants and carers attend together, as a way to normalise and talk about impaired speech. There are often few opportunities for carers to be involved in regular therapy, like speech groups. With ParkinSong, carers can sing and have fun and improve their own wellbeing while learning vocal strategies, such as voice projection, to support their partner at home.
To test whether the ParkinSong program is effective, the researchers conducted a 12-month trial in 2016 and 2017 involving 75 people with Parkinson’s and their carers. Participants were split into four groups. One group attended weekly ParkinSong sessions run by a music therapist and a speech pathologist. Another group attended monthly ParkinSong sessions coordinated by community musicians and volunteers with support from therapists. These two groups were compared with people who took weekly painting, dancing or tai chi classes or attended monthly peer support groups instead.
Before the trial, researchers measured the loudness of participants’ voices, speech clarity, breathing strength, and voice-related quality of life.
After three months, the researchers measured the participants again. They found that ParkinSong participants had increased the loudness of their voices. Over the same period, the voices of the people who did not participate in the program became less loud. People who attended weekly sessions increased their voice loudness more than people who attended monthly.
The researchers also found that ParkinSong was important for mental health and wellbeing. The social setting of the groups, along with the presence of carers and family, led to better mood, and increased confidence for communication. People who did not participate in the program reported a lower quality of life in relation to their communication.
The results of this study led Parkinson’s Victoria to establish 10 ParkinSong groups across Victoria in 2017 and 2018. The groups are open to anyone living with Parkinson’s, as well as their carers.
In 2020, the researchers began a new trial to test how ParkinSong compares with other types of music-based therapy. Participants will be randomly assigned to take part in ParkinSong therapy, or ParkinBeat drumming therapy. The results will be available in 2021.
NHMRC-ARC Dementia Research Development Fellowship (1106603) to Dr Jeanette Tamplin
University of Melbourne Early Career Researcher Grant
Louise B. M. Hanson-Dyer and J. B. Hanson Bequest
Tamplin J et al (2019) ParkinSong: A controlled trial of singing-based therapy for Parkinson’s disease.Neurorehabilitation and Neural Repair 33(6): 453–463. doi: 10.1177/1545968319847948
Image: University of Melbourne/Parkinson's Victoria
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